Endoscopic instrument



Oct. 22, 1935. F. c. WAPPLER 2,018,335

ENDOSCOPIC INSTRUMENT Filed Aug. 16, 1953 1N VENTOR l redaziok auu'la BY Y W ATT RIVEY Patented Oct. 22, 1935 UNITED STATES PATENT OFFICE 15 Claims.

My present invention relates generally to surgical instruments, and has particular reference to an improved endoscopic instrument of the general type illustrated and described in my copending application Serial Number 617,755, filed June 1'7, 1932.

The type of instrument to which my present invention is primarily applicable comprises an endoscopic tube with a lateral fenestra at its forward end, and a longitudinally movable electrode rod provided with a substantially transverse cutting loop at its forward end, the loop being adapted, when retracted, to engage the rear end of the fenestra in shearing relation. An instrument of this general type is highly eflicient in resecting longitudinal channels or the like through protrusions of internal body cavities.

The complete instrument includes, also, an illuminating and a telescopic means whereby the telescope commands a forwardly oblique field of vision, through the fenestra, the field being properly illuminated. The electrode rod or loop is constructed and arranged in such a manner that it normally projects outwardly through the fenestra, and is adapted to complete its cutting or resecting operation in shearing relationship with the rear end edge of the fenestra. This shearing action is of great advantage in efficiently and reliably finishing off the cutting operation which is being performed.

By virtue of the fact that the cutting loop is connected electrically to a source of suitable highfrequency current, the endoscopic tube must be so constructed that no short circuit occurs when the loop is brought into shearing relationship with the tube at the rear end of the fenestra. While the tube may, under certain circumstances, be connected with the indifferent terminal of the current source, this arrangement is not essential; but, in any event, the endoscopic tube must be retained in insulated relationship from the operative cutting loop. With this object in view, I have heretofore successfully constructed instruments in which the endoscopic tube is entirely of insulating material.

It is a general object of my present invention to provide a device of this type, wherein the necessity for constructing the endoscopic tube of insulating material has been obviated. A tube of suitable metal is, for various reasons, preferable to a tube of insulating material. It can be made thinner and less expensive, and it has a more polished appearance and character, which facilitates its insertion and removal from the body.

Briefly, my present invention provides an efiicient and novel means for providing a non-conductive edging on the fenestra of a metallic or conductive tube, thereby conditioning the tube for use in a cutting instrumentality of the general character hereinbefore discussed. 5

A particular feature of my invention lies in providing an insulating element of unique and particular character, adapted to be associated with a conductive endoscopic tube in a manner which accomplishes the general objective which is 10 sought. More particularly, the insulating element is associated with the fenestra of the endoscopic tube in a manner which positions certain edge portions of the element in substantial registry with the edges of the fenestra, thereby render- 15 ing the fenestra-non-conductive in character at its edges.

It is a further feature of my present invention to provide the insulating element in the form of a removable sleeve, adapted to be releasably secured 20 in position within the forward end of an endoscopic tube. In a preferred construction, the sleeve is insertable endwise into the forward end of the endoscopic tube, and is adapted to be held in position by means of a clamping arrangement 25 engaging the forward end of the insulating sleeve.

Further features of my invention lie in the manner of clamping the sleeve in position, whereby its applicability and removal from the endoscopic tube is facilitated, and whereby the instrument 30 as a whole, when assembled, partakes of a smooth,

efficient, and compact nature. For example, the clamping means of my present invention includes a clamping member adapted to form a smooth nose piece for the endoscopic tube as a whole.

A still further specific feature of my invention lies in providing the insulating element in a manner which permits the forward end of a telescopic instrumentality, or the like, to be efliciently accommodated within the tube, without any 40 interference between the insulating insert and the telescope or the like. Where the insert is in the form of a sleeve, its rear inner wall is provided with a rearwardly opening slot adapted to accommodate the forward end of a telescope or the like.

I achieve the foregoing objects, and such other objects as may hereinafter appear or be pointed out, in the manner illustratively exemplified in the accompanying drawing, wherein- 50 Figure 1 is a perspective view of an endoscopic instrument embodying the features of my present invention;

Figure 2 is a side elevational view of the insulating element by itself;

Figure 3 is a top view of Figure 2;

Figure 4 is a bottom view of the forward portion of the instrument of Figure 1;

Figure 5 is a cross-sectional view taken substantially along the line 5-5 of Figure 4; and

Figure 6 is a cross-sectional view taken substantially along the line 66 of Figure 5.

The endoscopic tube I0 is of metal and terminates at its rear end in a connecting sleeve H adapted to be associated in any desired and well known manner with instrumentalities which are to be inserted through the tube I0. In the present type of instrument, these instrumentalities will include a longitudinally movable electrode rod, carrying a substantially transverse cutting loop at its forward end, and an illuminating telescope for commanding visibility of the operative loop. These devices may be inserted into the tube ill in any desired manner, either singly or in the form of a bundle; and although I have illustrated the forward ends of these devices in the various figures,'I have made no attempt to illustrate the rear ends thereof nor the manner of associating them with the connecting sleeve ii, since such arrangements are wellknown, per se, in the art.

The tube ii) is of the character which embodies a lateral fenestra at its forward end, and in the illustrated embodiment the fenestra is of the type having a rear edge l2 but not a corresponding forward edge. The particular type of fenestra is, however, immaterial, so long as it is a lateral fenestra.

In the instrument shown by way of example, the rear wall l3 of the tube ii! (i. e., the wall opposite the fenestra) merges at its forward end into an upturned nose i4 having a longitudinal bore therethrough. The opposite or forward wall I 5 of the tube defines, at its forward end, the rear edge i 2 of the fenestra, and this rear edge merges into the side edges it which are substantially longitudinal, these side edges joining at their forward ends on the underside of the nose M. The rear wall 13 is preferably thickened or reinforced, as at ii, to rigidify the structure.

The tube is designed to accommodate a telescopic device It, which may be of any desired character but which is preferably of the type shown and illustrated in Patent No. 1,680,491, issued August 14, 1928. This type of telescope has a forwardly projecting lamp !9 and an objective 28 positioned behind the lamp and commanding a forwardly oblique field of vision through the lateral fenestra. The telescope is arranged along the rear wall 63 of the tube It).

The present instrument also includes a longitudinally movable electrode rod 20 supporting at its forward end a pair of upwardly arching springy arms 2!, these arms being connected at their forward ends to the rear ends of a U-shaped, substantially transverse cutting loop 22. The loop 22 normally positions itself as shown in Figure 5, whereby the midportion of the loop projects laterally out of the fenestra by a slight amount, and the several parts are so designed and constructed that when the electrode rod 20 is retracted the engagement of the loop 22 with the rear edge portions of the fenestra will cam the loop inwardly against the action of the springy arms 2|, thereby bringing the loop finally into shearing relationship with the rear edge of the fenestra. The retractive movement of the loop is designed to effect the cutting, by high-frequency current, of a longitudinal channel through an internal protrusion, and the final shearing relationship between the cutting loop and the fenestra serves to finish oil! the cut in an efficient manner.

As hereinbefore mentioned, it is essential that the loop 22 be maintained in insulated relationship from the endoscopic tube within which it is mounted, and it is therefore necessary that the shearing engagement between the loop and the rear edge of the fenestra be unaccompanied by any short-circuiting. In accordance with my present invention, I accomplish this objective by mounting an insulating element or sleeve of the character shown most clearly in Figures 2 and 3 in the forward end of the tube Ill.

The insulating element consists of a sleeve 23 having edge portions 24 and 25 which conform substantially to the edges l2 and iii of the fenestra in the tube Hi. The edges 2 and 25 may be said to define an opening in the sleeve 23, the opening being adapted to register substantially with the tube fenestra. However, the opening in the sleeve 23 is slightly smaller than the tube fenestra, so that when the sleeve is inserted, with the opening and fenestra in substantial registry, the edges 24 and 25 will slightly overlap the edges l2 and I6, respectively, as shown most clearly in Figures 4 and 5. This serves to render the edges of the tube fenestra nonconductive in character, or, stated otherwise, it provides for a non-conductive edging for the effective fenestra of the instrument.

The sleeve 23 is composed of any suitable rigid insulating material and is adapted to be inserted into the tube 0 in an endwise manner, It is held in position by a clamping arrangement which preferably consists of the two elements 29 and 23, both preferably of metal. The element 25 fits on the interior of the tube iii at the extreme forward tip thereof, and is provided with a threaded pin 28' which projects upwardly through a suitable opening 29 in the forward tip of the sleeve 23, and thence through the bore in the nose M. The element 21 is provided with an interiorly threaded bore adapted to engage over the pin 28; and in accordance with my invention the element 21 is shaped and configured to form a smooth ccntinuation of the nose thereby forming a blunted, smooth nosepiece for the instrument as a whole.

The engagement between the elements and 2? serves to clamp the forward end of the sleeve 23 into a secure association with the tube, whereby the edges 24 and 25 are properly positioned in relationship to the edges of the tube fenestra.

The sleeve 23 is further provided, at the rear of its inner wall, with a rearwardly opening, longitudinal slot 29. This slot is so positioned and arranged that it will accommodate the forward tip of the telescope is. As a result of this arrangement, the telescope may be accommodated in a compact and efficient manner, being posltioned closely adjacent to the rear wall is and hence well out of the way of the fenestra and of the operating instrument functioning therein.

When the insulating sleeve element has been inserted and secured in position, as shown in Figures 4 and 5, it will be observed that the edges of the resultant effective fenestra of the instrument are all of a non-conductive character. Accordingly, when the loop 22 is drawn rearwardly, it ultimately is brought into shearing relationship 'with the edge 24, as indicated in dot-and-dash lines in Figure 5. This prevents any undesired short-circuiting of the loop 22 and serves to render the tube as useful for the present purpose as a tube-composed entirely of insulating material.

The use of the present insulating insert is of further advantage in that is permits the tube III to be composed of extremely thin metal, thereby adding to the lightness and compactness of the entire instrument. The thinness of the tube is permissible because of the definite reinforcing effect which the rigid insulating sleeve has.

The application and removal of the sleeve is a matter of great simplicity, as will be readily understood, the elements 21 and 26 separating with ease and permitting the sleeve to be inserted or removed endwise from the tube III. This removability of the sleeve is of particular advantage from the standpoint of sterilization.

In general, it will be understood that changes in the details herein described and illustrated, for the purpose of explaining the nature of my invention, may be made by those skilled in the art without departing from the spirit and scope of the invention as expressed in the appended claims. It is, therefore, intended that these details be interpreted as illustrative, and not in a limiting sense.

Having thus described my invention, and illustrated its use, what I claim as new and desire to secure by Letters Patent is 1. In a device of the character described, a conductive endoscopic tube having a lateral fenestra at its forward end, and an insulating element carried by the tube along the margin of said fenestra to provide a non-conductive edging for said fenestra.

2. In a device of the character described, a conductive endoscopic tube having a lateral fenestra at its forward end, and an insulating element carried within the forward portion of the tube adjacent to the fenestra, said insulating element having edge portions disposed along the margin of said fenestra so as to provide a nonconductive edging for said fenestra.

3. In a device of the character described, a conductive endoscopic tube having a lateral fenestra at its forward end, and an insulating element carried within the forward portion of the tube adjacent to the fenestra, said insulating element having edge portions disposed along the margin of said fenestra and projecting slightly beyond the tube edges defining said fenestra, whereby the resultant effective fenestra has a non-conductive edging.

4. In a device of the character described, a conductive endoscopic tube having a lateral fenestra at its forward end, and an insulating sleeve carried within the forward portion of the tube and having edge portions disposed along the margin of said fenestra so as to provide a non-conductive edging for said fenestra.

5. In a device of the character described, a conductive endoscopic tube having a lateral fenestra at its forward end, and an insulating sleeve carried within the forward portion of the tube and having edge portions disposed along the margin of said fenestra and projecting slightly beyond the tube edges defining said fenestra, whereby the resultant effective fenestra has a non-conductive edging.

6. In a device of the character described, a conductive endoscopic tube having a lateral fenestra at its forward end, an insulating element removably carried by the tube along the margin of said fenestra to provide a non-conductive edging for said fenestra, and releasable means for securing said element in position.

7. In a device of the character described, a conductive endoscopic tube having a lateral fenestra at its forward end, an insulating element removably carried by the tube along the margin of said fenestra to provide a non-conductive edging for said fenestra, and releasable means for securing said element in position, said means including a clamp which forms a smooth nose piece for the tube.

8. In a device of the character described, a conductive endoscopic tube having a lateral fenestra at its forward end, an insulating element removably carried by the tube along the margin of said fenestra to provide a non-conductive edging for said fenestra, and releasable means for securing said element in position, said means comprising a pair of complementary clamps adapted to sandwich between them the forward ends of said element and tube.

9. In a device of the character described, a conductive endoscopic tube having a lateral fenestra at its forward end, an insulating element removably carried by the tube along the margin of said fenestra to provide a. nonconductive edging for said fenestra, and releasable means for securing said element in position, said means comprising a pair of complementary clamps one of which is provided with a pin extending through the forward ends of said element and tube, the other engaging said pin.

10. In a. device of the character described, a conductive endoscopic tube having a lateral fenestra at its forward end an insulating element removably carried by the tube along the margin of said fenestra to provide a nonconductive edging for said fenestra, and releasable means for securing said element in position, said means comprising a pair of complementary clamps one of which is disposed within the tube adjacent to the forward tip thereof, the other of which is disposed outside of the tube and forms a smooth nose piece for the tube, said clamps engaging between them the forward ends of said element and tube.

11. In a device of the character described, a conductive endoscopic tube having a lateral fenestra at its forward end, an insulating sleeve removably insertable endwise into the forward portion of the tube, said sleeve having edge portions conforming substantially to the tube edges defining said fenestra, whereby the fenestra 1s rendered non-conductive at its edges, and releasable means engaging the forward end of said sleeve and tube to secure the sleeve in position.

12. In a device of the character described, a conductive endoscopic tube having a lateral fenestra at its forward end, an insulating sleeve removably insertable endwise into the forward portion of the tube, said sleeve having an opening which conforms substantially to said fenestra but is slightly smaller than the latter, whereby said fenestra is provided with a non-conductive edging, and a pair of clamps releasably engaging the forward ends of said sleeve and tube to hold the sleeve in position.

13. In a device of the character described, a conductive endoscopic tube having a lateral fenestra at its forward end and an insulating sleeve carried within the forward portion of the tube and having edge portions disposed along the margin of said fenestra so as to provide a nonconductive edging for said fenestra, the rear inner wall of the sleeve having a rearwardly opening slot adapted to accommodate the forward end of an illuminating telescopic instrumentality.

14. In a device of the character described, a

conductive endoscopic tube having a lateral fenestra at its forward end, a telescope in said tube arranged along the rear wall thereof to command a forwardly oblique field of vision out of said fenestra, and an insulating sleeve carried in the tube and provided with edge portions which overlap the edges of said fenestra so as to render said fenestra edges nonconductive, the rear end of the sleeve having a slot adapted to accommodate the forward end of said telescope.

15. In a device of the character described, a

conductive endoscopic tube having a lateral fenestra at its forward end, a longitudinally movable electrode rod mounted in said tube and provided at its forward end with a transverse cutting loop adapted, when retracted, to engage the rear edge of the fenestra in shearing relation, and an insulating sleeve carried in the tube and provided with edge portions which overlap the edges of said fenestra so as to render the latter non-conductive. 

